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Aims: The study evaluated the associations between glycometabolic parameters at admission and during hospitalization and 2 year all-cause mortality risk in an unselected cohort of consecutive patients with diabetes admitted for unstable angina or non-Q-wave myocardial infarction to a university hospital during 1988-98., Methods and Results: A total of 713 consecutive patients with diabetes were included. During 2 years of follow-up, 242 (34%) patients died. All analyses were retrospective using prospectively collected clinical data. The primary study endpoint was 2 year all-cause mortality collected from the Swedish cause-specific mortality register. In unadjusted analyses, high admission blood glucose (highest vs. lowest quartile: hazard ratio (HR) 2.66; 95% confidence interval (CI) 1.83, 3.86) and hypoglycaemia recorded during hospitalization (hypoglycaemia vs. normal: HR 1.77; 95% CI 1.09, 2.86) were both significantly associated with increased 2 year all-cause mortality risk. These associations remained significant after multivariable adjustment., Conclusion: In the setting of acute coronary syndromes (ACS) among patients with diabetes, hyperglycaemia on arrival and hypoglycaemia during hospitalization are both independently associated with worse adjusted all-cause 2 year mortality risk. These observations suggest that the avoidance of both hyper- and hypoglycaemia during ACS events may be of similar importance, and glucose modulation remains an important objective to address in future randomized trials.

Objective: The aims of this study were to investigate the prognostic influence of diabetes after an episode of unstable angina pectoris or non-Q-wave myocardial infarction (MI) and to investigate whether diabetes is independently associated with increased short- and long-term mortality risk following these episodes., Design: Consecutive patients with a diagnosis of unstable angina pectoris or non-Q-wave MI, admitted to the Coronary Care Unit at Ostra Hospital, Göteborg, Sweden during 1988-1998 were included. The primary endpoint was 2-year mortality collected from the Swedish cause-specific mortality register., Results: The study included 4341 patients, 722 (17%) had diabetes. Diabetes was associated with increased mortality during initial hospitalization (10.2% vs 5.7%, p < 0.0001), after 30 days (13% vs 7.5%, p < 0.0001), and at 2 years (33.7% vs 20.2%, p < 0.0001). After adjustment for potentially confounding factors, diabetes remained an independent predictor of 2-year mortality following unstable coronary syndromes, the hazard ratio (HR) of death (HR = 1.6; 95% CI 1.4-1.9)., Conclusions: Among patients with unstable coronary syndromes, diabetes is an independent risk factor associated with increased mortality during hospitalization, short- and long-term follow-up.